title: Validation assessment of risk scores to predict postthrombolysis intracerebral haemorrhage.
abstract: BACKGROUND
  Two clinical risk scores, the Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores, have been proposed to predict the risk of intracerebral haemorrhage following thrombolysis in acute ischaemic stroke.
  
  
  OBJECTIVE
  To validate Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores as predictors of post-tissue plasminogen activator symptomatic intracerebral haemorrhage and asymptomatic intracerebral haemorrhage in an independent cohort.
  
  
  METHODS
  Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores were calculated for the cohort of tissue plasminogen activator-treated patients enrolled in the placebo arms of the SAINT-I and SAINT-II trials. The absolute risk of symptomatic intracerebral haemorrhage and asymptomatic intracerebral haemorrhage associated with each scoring system was determined. The overall predictive value was assessed using c-statistics.
  
  
  RESULTS
  Symptomatic intracerebral haemorrhage occurred in 5.6% of 965 patients treated with tissue plasminogen activator in the SAINT cohorts. The risk of symptomatic intracerebral haemorrhage was modestly greater, with higher Haemorrhage After Thrombolysis scores (0: 4.1%, 1: 4.1%, 2: 8.8%, 3: 12.5%, 4: 0%, 5: no subjects). Similar results were seen with the Multicentre Stroke Survey score (0: 0%, 1: 4.8%, 2: 2.3%, 3: 7.3%, 4: 6.3%). In logistic regression, the Haemorrhage After Thrombolysis score was associated with the risk of symptomatic intracerebral haemorrhage (odds ratio = 1.41 per point, 95% confidence interval: 1.05-1.89, P = 0.021) and asymptomatic intracerebral haemorrhage (odds ratio = 1.59 per point, 95% confidence interval: 1.33-1.92, P< 0.001). The Multicentre Stroke Survey score was modestly associated with the risk of symptomatic intracerebral haemorrhage (odds ratio = 1.43 per point, 95% confidence interval: 0.95-2.15, P = 0.084) and asymptomatic intracerebral haemorrhage (odds ratio = 1.63 per point, 95% confidence interval: 1.27-2.08, P < 0.001). The c-statistic was 0.59 for predicting symptomatic intracerebral haemorrhage and 0.61 for asymptomatic intracerebral haemorrhage for both the Haemorrhage After Thrombolysis and the Multicentre Stroke Survey scores.
  
  
  CONCLUSIONS
  While both the Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores were associated with a risk of symptomatic intracerebral haemorrhage, discriminatory ability was limited.
authors.affiliation: Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. cucchiar@mail.med.upenn.edu
authors.forename: Brett
authors.initials: B
authors.lastname: Cucchiara
authors.forename: Scott
authors.initials: S
authors.lastname: Kasner
authors.forename: David
authors.initials: D
authors.lastname: Tanne
authors.forename: Steven
authors.initials: S
authors.lastname: Levine
authors.forename: Andrew
authors.initials: A
authors.lastname: Demchuk
authors.forename: Steve
authors.initials: S
authors.lastname: Messe
authors.forename: Lauren
authors.initials: L
authors.lastname: Sansing
authors.forename: Kennedy
authors.initials: K
authors.lastname: Lees
authors.forename: Patrick
authors.initials: P
authors.lastname: Lyden
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator